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REPORT OF THE RESIDENT MEDICAL OFFICER OF THE APIA HOSPITAL, 1926. Administration. The hospital buildings, including the Sisters' Home, have been painted throughout during the last year, making a very noticeable improvement. The whole of the hospital is now electrically lit, and with few exceptions the plant has worked well. At one period the load was too great for the engine, so three outside houses which were supplied by our plant were transferred to the Apia main, giving far better lighting in the hospital. Very shortly we shall be supplied from the turbine at the Motootua Ice-works, which will give us an all-night supply, instead of only five hours as at present. Our own plant will be retained to enable us to run the X-ray apparatus at will, and also ag a stand-by in case of a shortage of water during the dry season. It has long been recognized that the present maternity department attached to the European hospital is inadequate, being too near the other wards and the road ; besides which there are not enough private wards to accommodate other female patients. Plans are now prepared for a new maternity department on the north-west corner of the European block, consisting of a labour-room, two convalescing-rooms, sink-room, sterilizing-room, offices, &c., and this will be commenced early in March, and will be a great improvement. Owing to the expansion of our Samoan nursing staff a new fale has been found necessary, and at the time of writing is about completed. This will enable us to accommodate twenty-seven nurses. The fale is situated nearer the Ifi. Ifi Road than the other two fales, and is built on higher ground. A new shower and lavatory will be added to the existing buildings, and these additions should provide ample accommodation for years to come, and should provide comfortable quarters for the Samoa,n nurses. The hospital has up to now been supplied with water from two sources, Yailima and the Apia main. The latter was very unsatisfactory, failing when most wanted, so during the last two months of the year all the buildings have been connected up with the Yailima supply. The Samoan nurses' quarters, the Sisters' Home, and the Resident Medical Officer's residence are thus assured of a constant supply of water with ample pressure. It has been felt for a long time that the food problem was a serious one for patients coming to the Samoan Hospital from a distance. Many cases have not been able to avail themselves of the necessary treatment on this account; ( so it was decided to evolve a scheme to meet this difficulty, and it was considered that the only solution was the acquiring by the Medical Department of sufficient land in the vicinity of the hospital to provide both housing and food for patients. As a result, during the latter part of the year, two properties have been acquired, totalling nearly 14 acres. Of this area 8 acres is just beyond the Resident Medical Officer's house, and the remainder is continuous with the southern boundary of the hospital grounds, containing on it a well-built wooden house. The 8 acres were cleared by the end of the year and planted in breadfruit, taro, and bananas. The work was begun by the boys from Avele and Malifa Schools, and finished by the teachers attending the refresher course at Malifa School. Owing to good rains since planting the crops are already well established, and we can confidently look for good results during the latter part of 1927. Later on, when a suitable area near the hospital can be found, it is proposed to build a village of Samoan fales (houses). The scheme as outlined above necessitates a place of residence for the attendants and patients coming from a distance, and the idea is that two attendants shall accompany each patient, one of whom will stay with the patient in the hospital, whilst the other lives in the village, working on the plantation in return for the food supplied to him and the patient. It is confidently anticipated that this scheme will be a success, the chief obstacle in sight being the difficulty of obtaining suitable land for the purpose near the hospital. The housing of married members of the hospital medical staff has up to now been a very difficult matter, as so few suitable houses are available, and, if so, are too far away. The problem has been most successfully solved by renovating the house on the property at the southern end of the grounds, which provides us with three good residences all within a very short distance of the hospital. We hope in time to have a hospital telephone system, which will still further simplify matters. The maternity fale at the Samoan end was opened in July last, and has proved an unqualified success, no fewer than eighteen maternity and gynaecological cases having presented themselves. Of these six were normal labours, and have been of very great benefit to our nurses. The maternity sister is in charge, assisted by a trained Samoan nurse, who is also sub-matron of the Samoan nurses. The maternity sister lectures once a week to the nurses on elementary midwifery, and this, with the practical experience gained, will enable us shortly to send our nurses to the out-stations trained in every branch of their profession. Statistics. The analysed hospital statistics, as in last year's report, are compiled for the calendar year 1926. Treatment —Medical. At the end of February an epidemic of dysentery commenced, and lasted on until July. In all 113 cases were admitted, with thirteen deaths. As previously noted, in Western Samoa the type was exclusively bacillary, and shiga was the organism, but not of a very virulent type. Most of the deaths were due to delay in coming to hospital. There were a number of cases in the villages round both islands. No sooner had the dysentery epidemic settled down than a mild form of influenza took its place, and eighty-two were admitted suffering from it. A large number of our Samoan staff were affected, but there was no death from this cause. Lobar pneumonia accounted for forty-six admissions, with five deaths, but there were very few cases of broncho-pneumonia. Yaws are still decreasing, the number of injections being 798 less than last year, and one only has to look round the villages to see the improvement that has taken place. Admissions due to the enteric-fever group are small in number, but with one exception all gave a positive Widal reaction.

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